Week 11 Sherpath: Junctional Dysrhythmias

An ECG is performed on a 25-year-old patient with no significant medical history. The patient reports that he has been up all night "drinking tons of coffee to stay awake." The ECG shows an inverted P wave that occurs just before the QRS complex. The patient reports palpitations and has mild hypertension. How does the nursing team manage the plan of care of this patient? A. Encourage the patient to decrease daily caffeine intake B. Talk to the patient about the need for an implanted pacemaker C. Talk to the patient about the need for an emergency electrical cardioversion D. Educate the patient in measuring the radial pulse prior to taking a beta-blocker

A. Encourage the patient to decrease daily caffeine intake Junctional dysrhythmias may be caused by certain drugs (e.g., caffeine). Discontinuation of the drug is indicated to manage the dysrhythmia.

A patient with a history of third-degree heart block comes to the ED with severe chest pain and bradycardia. Which serious medical complication does the nursing team need to prepare for in caring for this patient? A. Shock B. Digoxin toxicity C. Diabetes mellitus D. Cerebralvascular accident

A. Shock Third-degree AV block usually results in reduced cardiac output with subsequent ischemia, HF, and shock.

The nurse examines the patient's ECG and notices that there is a junctional rhythm. Which area of the heart is controlling the heart rate? A. SA node B. AV node C. Ventricles D. Purkinje fibers

B. AV node Junctional dysrhythmias refer to dysrhythmias that start in the area of the AV node to the bundle of His known as the AV junction.

A patient in the cardiac unit has an ECG reading showing a regular rhythm, normal P wave, prolonged PR interval (greater than 0.20 second), and normal QRS complex. What is the next step in nursing management for this patient? A. Give atropine IV push B. Continue to monitor the patient C. Prepare for transcutaneous pacing D. Teach the patient about second-s-degree heart block

B. Continue to monitor the patient This patient is displaying signs of first-degree heart block. There is no treatment for first-degree AV block. Monitor patients for any new changes in heart rhythm (e.g., more serious AV block).

A patient with a history of HF reports chest pain. An ECG shows a prolonged PR interval that remains constant on conducted beats. The QRS complex is 0.14 seconds. Which action does the nurse take for management of this patient? A. Monitor the patient B. Prepare the patient for insertion of a temporary pacemaker C. Prepare to administer dopamine D. Advise the patient to discontinue anticoagulants

B. Prepare the patient for insertion of a temporary pacemaker The patient is exhibiting a type II second-degree heart block. Because the patient is symptomatic, insertion of a temporary pacemaker may be necessary before the insertion of a permanent pacemaker.

A 59-year-old patient arrives at the emergency department and with chest discomfort for the past 24 hours. An ECG reading shows a heart rate of 58, a regular rhythm with a normal QRS complex, and an inverted P wave on the fourth beat. Which conclusion can be made about the intrinsic pacemaker in this patient's heart? A. The SA node is functioning normally as the pacemaker of the heart. B. The impulse is coming from the AV node, because the SA node is either not functioning or the impulse is blocked. C. The AV node is not functioning properly as the primary pacemaker of the heart. The impulse is coming from the SA node. D. Neither the SA node or the AV node are functioning as the pacemaker of the heart. The impulse is coming from random areas of the heart.

B. The impulse is coming from the AV node, because the SA node is either not functioning or the impulse is blocked. In junctional rhythms, the AV node becomes the pacemaker of the heart, producing an abnormal P wave that is hidden in the QRS complex. The impulse usually moves normally through the ventricles.

A 65-year-old patient with a 20-year history of CAD receives an ECG that shows a variable PR interval with no relationship between the P wave and the QRS complex. The nurse notes which type of heart block? A. First-degree heart block B. Third-degree heart block C. Second-degree heart block type I D. Second-degree heart block type II

B. Third-degree heart block In third-degree heart block, the PR interval is variable, and there is no relationship between the P wave and the QRS complex.

The nurse is caring for several patients. To which patient would the nurse expect to administer atropine? A. Patient with first-degree heart block B. Patient with third-degree heart block C. Patient with second-degree heart block type I D. Patient with second-degree heart block type II

C. Patient with second-degree heart block type I For the patient with second-degree heart block type I who is symptomatic, atropine is used to increase heart rate.

In which type of AV block will a nurse expect to see a gradual lengthening of the PR interval? A. First-degree heart block B. Third-degree heart block C. Type I second-degree heart block D. Type II second-degree heart block

C. Type I second-degree heart block Type I second-degree AV block includes a gradual lengthening of the PR interval.

Two months after being diagnosed with myocardial infarction, a patient returns for a checkup. A routine ECG shows a 2:1 then 3:1 ratio (indicating two P waves to one QRS complex, then three P waves to one QRS complex). The nurse anticipates educating the patient about which dysrhythmia? A. First-degree heart block B. Third-degree heart block C. Second-degree heart block type I D. Second-degree heart block type II

D. Second-degree heart block type II In type II second-degree AV block, a certain number of impulses from the SA node are not conducted to the ventricles. This occurs in ratios of 2:1, 3:1, and so on (i.e., two P waves to one QRS complex, three P waves to one QRS complex). It may occur with varying ratios.

A 39-year-old female patient presents to the emergency department with chest discomfort for the past 2 days. In obtaining the patient history, the nurse discovers the patient has a history of coronary artery disease. The patient's ECG shows a normal P wave, prolonged PR interval widened QRS complex, and an irregular ventricular rhythm. The nurse knows that these symptoms are indicative of which heart rhythm? A. First-degree AV block B. Third-degree AV block C. Type I second-degree AV block D. Type II second-degree AV block

D. Type II second-degree AV block Type II second-degree AV block is associated with coronary artery disease. The P wave is typically normal in shape, the PR interval may be prolonged, and the QRS complex is typically greater than 0.12 second due to a bundle branch block.