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Interactive Review | Dysrhythmias
Lewis Chapter 36
Terms in this set (60)
The patient has an electrocardiographic (ECG) tracing that is 50 beats/minute, the rhythm is regular, and there is a P wave before every QRS complex. The QRS has a normal shape and duration, and the PR interval is normal. What is you response?
Monitor the patient for syncope • the rhythm described is sinus bradycardia
Treatment of sinus bradycardia
depends on patient's response and whether adequate perfusion is occurring. If patient tolerates the rhythm, no treatment is given.
The emergency department patient is in paroxysmal supraventricular tachycardia (PSVT) at a rate of 170 beats/minute. Which treatment do you anticipate first?
Adenosine by fast IVP
PVST is a dysrhythmia originating in an:
ectopic focus anywhere above the bifurcation of the bundle of His.
Treatment of PSVT includes
vagal stimulation (Valsalva maneuver, coughing) and IV adenosine as the first drug of choice. Other drugs include beta blockers, Ca+ channel blockers, and amiodarone. Defibrillation is used if vagal stimulation and drug therapy are ineffective and pt becomes hemodynamically unstable.
treats PSVT • short half-life • given rapid IVP
Digoxin is used for
The patient has chronic A-Fib. What action do you anticipate?
Teaching the patient to take an anticoagulant daily (usually warfarin (Coumadin))
chaotic atrial activity results in blood stasis that can lead to embolic events • anticoagulants given to prevent emboli formation • the P wave is absent and is replaced by chaotic fibrillatory waves • Defibrillation is an elective procedure for chronic AF and is performed at low levels of electricity
The patient has a heart rate of 40 beats/minute. The P waves are regular, and the Q waves are regular, but there is no relationship between the P wave and QRS complex. What treatment do you anticipate?
This rhythm indicates 3rd degree AV block.
In 3rd degree AV block
there is no correlation b/w impulse from atrium to the ventricles and the ventricular rhythm seen. Pacemaker is eventually required. If left untreated, ongoing reduced cardiac output will result in ischemia. This is a conduction issue, not abnormal contraction..defibrillation is not used
A carotid massage
is vagal stimulation that can cause bradycardia
When computing a heart rate from the ECG tracing, you count 15 of the small blocks between the R waves of a patient whose rhythm is regular. From these data, you calculate the patient's heart rate to be what?
Because each small block on the ECG paper represents 0.04 second, 1500 of them represent 1 minute. By dividing the number of small blocks (15 in this case) into 1500, you can calculate the heart rate in a patient whose rhythm is regular (in this case, 100).
Which statement best describes the electrical activity of the heart represented by measuring the PR interval on the ECG?
The length of time for the electrical impulse to travel from the sinoatrial (SA) node to the Purkinje fibers
The route of the electrical impulse:
SA node -> AV node -> Purkinje fibers • this has happen for synchronous atrial and ventricular contraction to occur
The P wave represents
part of the QRS complex that represents ventricular contraction
When measuring the time from beginning of the P wave to the beginning of the QRS
(also known as PR interval), you are identifying the length of time it takes for the electrical impulse to travel from the SA node to the Purkinje fibers
You obtain a 6-second rhythm strip, and document the following analysis: atrial rate of 70 beats/minute, regular; ventricular rate of 40 beats/minute, regular; QRS of 0.04 second; no relationship between P waves and QRS complexes; and atria and ventricles beating independently of each other. What is the correct interpretation of this rhythm strip?
Third-degree heart block..which represents a loss of communication between the atrium and ventricles. This is depicted on the rhythm strip because there is no relationship between the P waves, representing atrial contraction, and QRS complexes, representing ventricular contraction. The atria are beating totally on their own at 70 beats/minute, whereas the ventricles are pacing themselves at 40 beats/minute.
You are watching the cardiac monitor, and a patient's rhythm suddenly changes. There are no P waves. Instead, there are fine, wavy lines between the QRS complexes. The QRS complexes each measure 0.08 second (narrow), but they occur irregularly with a rate of 120 beats/minute. You correctly interpret that this rhythm is
Atrial fibrillation is represented on the cardiac monitor by
irregular R-R intervals and small fibrillatory waves • there are no normal P waves because the atria are not contracting, just fibrillating
For which dysrhythmia is defibrillation primarily indicated?
Pacemakers are the treatment of choice for
third-degree heart block
A patient in asystole is likely to receive which drug treatments?
Atropine and epinephrine, which may prompt the return of depolarization and ventricular contraction
Which ECG characteristics are consistent with a diagnosis of ventricular tachycardia (VT)?
Rate of 200 beats/min and a P wave that is not visible
V-Tach is associated with:
rate of 150-250 beats/min, non-visible P wave
Rate and rhythm are unmeasurable in which dysrhythmia?
A patient admitted with acute coronary syndrome (ACS) has continuous ECG monitoring. An examination of the rhythm strip reveals the following characteristics: atrial rate of 74 beats/minute and regular; ventricular rate of 62 beats/minute and irregular; P wave with a normal shape; PR interval that lengthens progressively until a P wave is not conducted; and QRS complex with a normal shape. Your priority nursing intervention involves:
Observing for s/s of hypotension or angina. The rhythm indicates 2nd-degree AV block (Type I).
2nd degree AV block
identified by a gradual lengthening of the PR interval. Type I AV block is usually a result of myocardial ischemia or infarction and typically is transient and well tolerated. Assess for bradycardia, hypotension, and angina. If pt becomes symptomatic, atropine or temporary pacemaker may be needed.
You are monitoring the electrocardiogram of a patient admitted with ACS. Which ECG characteristics most suggest ischemia?
Sinus rhythm with a depressed ST segment or T-wave inversion, or both
The ECG monitor of a patient in the cardiac care unit after a myocardial infarction (MI) indicates ventricular bigeminy with a rate of 50 beats/minute. You anticipate
assessing the pt's response to the dysrhythmia
when every other beat is a PVC.
usually benign finding in pt with a normal heart. In heart disease, PVCs may reduce cardiac output and precipitate angina and heart failure, depending on frequency.
PVCs in pt with heart issue
indicates ventricular irritability and the patients physiologic response to the rhythm should be monitored
Assessment of a patients hemodynamic status is important to determine:
whether treatment with drug therapy is needed
You prepare a patient for synchronized cardioversion knowing that cardioversion differs from defibrillation in that
patients should be sedated if cardioversion is done on a nonemergent basis
therapy of choice for pt with hemodynamically unstable ventricular or supraventricular tachydysrhythmias. A synchronized circuit in the defibrillator delivers a countershock that is programmed to occur on the R wave of the QRS complex seen on the ECG tracing. The synchronizer switch must be turned on when cardioversion is planned. The initial energy needed for synchronized cardioversion is less than the energy needed for difibrillation.
What term is applied to a pacemaker that is implanted for the purpose of terminating atrial tachycardias?
involves pacing atrium at a rate of 200 to 500 impulses per minute in an attempt to terminate atrial tachycardias (A-flutter with rapid ventricular response)
used temporarily with the power source outside the body
delivers stimulus to the ventricle to terminate tachydysrhythmias.
Cardiac resynchronization therapy
technique to resynchronize cardiac cycle by pacing both ventricles
The charge nurse is explaining the concept of pacemaker failure to capture to the new graduate. What information should the charge nurse give?
It occurs when the electrical charge is insufficient to produce atrial or ventricular contraction.
Failure to capture can result in
serious bradycardia • treatment includes increasing electrical charge
Failure to sense
occurs when pacemaker fails to recognize spontaneous atrial or ventricular activity and fires inappropriately (this can happen r/t ventricular tachycardia)
The patient has a permanent cardiac pacemaker. On the electrocardiographic tracing, you notice a spike before each P wave. What action should you take?
Document the findings
A spike before each P wave
indicates pacemaker is firing and the atrium is responding to the impulse • it is a normal, expected finding when a pacemaker is present
The patient has a pacemaker set for 70 beats/minute. When taking the patient's pulse, you obtain a heart rate of 60 beats/minute. What is the best interpretation of this finding?
The pacemaker is not working properly
Which teaching points should you include when providing discharge instructions to a patient with a new permanent pacemaker and to the caregiver (select all that apply)?
Take and record a pulse rate daily • obtain and wear a medic alert ID or bracelet at all times • avoid lifting the arm on the side of the pacemaker above the shoulder
Important teaching for the patient scheduled for a radiofrequency catheter ablation procedure includes explaining that
the procedure will destroy areas of the conduction system that are causing rapid heart rhythms
Radiofrequency catheter ablation therapy
uses electrical energy to "burn" or ablate areas of the conduction system as definitive treatment for tachydysrhythmias
You are caring for a patient 24 hours after pacemaker insertion. Which nursing intervention is most appropriate at this time?
Assessing the incision for any redness, swelling, or discharge.
Post-pacemaker insertion considerations
limit activity of involved arm to minimize pacemaker lead displacement • nonpressure dressing should be kept dry until removed, usually 24h post-op • observe for s/s of infection
An elderly patient presents to the emergency department after a fall. She states she does not remember the incident. What is most important to assess first?
Heart rate and rhythm. Determining a cardiac cause for this brief lapse of consciousness is most important. Subsequent assessments will include hemoglobin, home environment, and alcohol consumption
The female patient presents to the emergency department just after a syncope episode. What should you assess first?
Capillary glucose level
Hypocalcemia could be the cause and would be easily treated. Ruling out simple treatable cause should be done first.
What should always be assessed when there is a change in level of consciousness?
Glucose and oxygen (and cardiac) should be assessed first.
What is the purpose of the head-up tilt test?
To determine whether there is positional decreased venous return to the heart.
How is cardioneurogenic syncope tested?
Head-up tilt test • measures for increased venous pooling that occurs in upright position
A patient has sought care after an episode of syncope of unknown origin. Which nursing action should you prioritize in the patient's subsequent diagnostic workup?
Preparing to assist with a head-up tilt test
Common test performed after episodes of syncope?
head-up tilt test
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