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99 Cards in this Set
- Front
- Back
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Is a standard 2 lead AKG diagnostic?
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no
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What is diagnostic for EKG
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12 lead
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How do you attach electrodes for EKG
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White on Right
Smoke over Fire (Black over Red) |
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What do you do if you remove EKG
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inform nurse
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How often do you change EKG leads
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every few days
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What is the hearts natural pacemaker?
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SA node/ Sinus Node
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Where is the SA node located
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upper wall of the right atrium
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What does P wave represent
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Atrial depolarization and contraction
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Where does wave go after SA node
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AV node, where it pauses before penetrates
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Where does depolarization go after AV node
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Bundle of His, Bundle branches, Purkinje fibers
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What occurs after depolarization reaches Purkinje fibers?
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ventricular contraction occurs
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What is QRS on EKG?
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ventricular depolarization and contraction
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ST segment is usually
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flat with baseline and reflects pause
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What does T wave represent?
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ventricular repolarization
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What does P wave look like
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small and smooth
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What does PR interval start and end with?
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P and R
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What does QRS look like
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sharp adn tall
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What does ST segment look like
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flat
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What does T wave look like
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small and smooth
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What does each little box on EKG graph paper equal
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0.04 seconds
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What does each darker line on EKG graph paper equal
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0.2 seconds
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How do you calculate HR
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six second strip and multiple QRS complexes by 10
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What is normal sinus rhythm
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P wave before QRS
QRS present T wave present after QRS rhythm regular rate between 60 and 100 |
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What is sinus bradycardia?
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same as sinus rhythm but beat is 40-60 bpm
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Treatment for sinus bradycardia
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if symptomatic, give atropine
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What can be a common cause of sinus bradycardia?
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bearing down
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What is normal dose of atropine
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0.5-1.0 mg
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What are signs of low cardiac output
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decreased LOC, cold extremity, decreased pulse ox, cyanosis, weak pulses, decreased urine output, dizzy, metabolic acidosis (after a while), decreased GI motility
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What is treatment for sinus brady besides atropine?
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permanent pacemaker insertion
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What are some causes of sinus bradycardia?
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inferior wall MI (near SA node, blocks it), Addison's Disease, increased ICP, digoxin, beta blockers, normal during sleep and in athelets, vagal stimulation
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What is sinus tachycardia?
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same as sinus but rate is over 100 bpm
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Treatment for sinus tachy?
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identify cause and fix
(ex: dehydration, anxiety) |
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Some causes of sinus tachy?
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normal response to Sympathetic NS and to anything that increases metabolic rate (fever, fear, exertion, alcohol, caffeine, nicotine, atropine, catecholamines, MI, PE, heart failure, hypoxemia, anemia, hypovolemia, thyrotoxicosis)
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What are nursing implications with sinus tachy?
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watch for hypertension or decreased CO
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Why might alcohol cause sinus tachy?
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it causes dehydration
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What does A fib look like?
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can't find P wave or T wave
rhythm irregular could be any rate, but over 100 is considered uncontrolled |
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What is treatment for A fib?
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beta blocker, Calcium channel blocker, cardioversion
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What is cardioverson
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synch or shock on R wave; patient is sedated adn clear
usually only do on a fib during first change, because later may release clot |
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Messed up P wave =
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messed up atrium
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What are some causes of A fib?
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can occur in healthy or in cardiac problems
excessive alcohol, heart failure, rheumatic heart disease, HTN, hyperthyroidism, post op open heart |
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What is atrial reentry during A fib?
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AV node is bombarded with multiple impulses to atria but only a few get through to ventricles
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What should you check for with A fib
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embolism or signs of decreased CO
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What is atrial kick
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decreases CO by 15-30% and increases risk for MI and HF
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What is patient with A fib usually put on
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coumadin or ASA to prevent thromboembolitic event
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What does A flutter look like?
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More than one P wave (saw tooth appearance), can't really see T wave
rhythm usually regular Ventricular rate is normal, but atrial rate 250-300 |
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what is treatment for A flutter?
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same for A fib
monitor clots and decreased CO |
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What are some causes of A flutter?
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heart disease (rheumatic coronary, heart failure, pericarditis, PE)
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What is reentry conduction with A flutter?
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atrium beats not fibrillates 2:1 or 4:1
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what do you observe for in A flutter
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s/s decreased CO and thrombosis
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What does V tach look like?
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No P wave, No T wave, rhythm regular and rate varies
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What is treatment for V Tach?
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If patient alert, Lidocaine first!
If patient is out, shock them no doubt! |
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What can you give for alert VTach?
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Lidocaine or
Amiodarone (Cordarone) 150 mg IV |
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What do QRS look like with V tach?
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big, wide, and bizarre
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What are some causes of V tach?
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ectopic focus in the ventricles, and re-entry phenomeonon
Cardiac irritability: CAD, MI, cardiomyopathy, electrolyte imbalance (especially K and MG) |
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What is nursing implications for V Tach?
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nursing EMERGENCY!
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What do you look for in V Tach?
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s/s of decreased CO
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What meds can you give for Alert V Tach?
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Amiodarone 150 mg IV over 10 minutes
Lidocaine 0.5 to 0.75 mg/kg IV push, then defibrillate |
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What are some other treatments for patients with recurrent V Tach?
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AICD (automatic internal cardiac defib)
EPS studies Ablation |
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What are PVCs
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ectopic beat originating in ventricles below the bundle of His. Comes become next expected beat
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What are PVCs associated with?
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stimulants like caffeine, alcohol, isuprel, diseases, HF, AMI, CAD
can be unifocal or multifocal |
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When should you worry about PVC
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if a lot of them
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What is treatment for PVC
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if over 6 a minute, give Lidocaine
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what are you worried about with PVCs
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may turn to V tach
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Do you count PVC's in EKG strip
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no! not regular
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What should you check if you have PVCs
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POTASSIUM LEVEL!
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What does V fib look like
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NO Pwaves, No regular QRS, no T waves, rhythm irregular, can't count rate
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What is treatment for V fib
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CPR!! SHOCK SHOCK SHOCK!!!
200, 300, 360 |
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What are other treatments/ meds for V fib
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epinephrine 1 mg IV or vasopressin 40 Units IV
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What pulse should you check to see if CPR effective?
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femoral
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Who can do CPR?
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anyone certified
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Causes of V fib
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multiple ectopic foci in teh ventricles causes disorganized fibrillation to ventricles
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What is nursing implication for V fib
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no contractions = No CO
most common cause sudden cardiac death treat quickly to avoid death! |
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What is asystole?
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no P wave, QRS, T wave, rhythm, or rate
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What is treatment for asystole
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CPR, transcutaneous pacing, Epi, Atropine
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What do you give first with asystole
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Epi or atropine
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what should you do if pt goes into aysstole
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put in IV for a lifeline and leave in until leaving
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What are some causes of asystole?
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hypoxia, hyperkalemia, hypokalemia, acidosis, druge overdose, hypothermia
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what are nursing implications for aystole?
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medical emergency
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How do you treat asystole
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treat underlying cause
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What are types of pacemakers
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transcutaneous (across skin), internal (IV)
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What does pacemaker do?
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serves as pulse generator to send electrical stimulus to myocardium
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What is pacemaker used to treat?
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bradycardia, asystole, and AV blocks
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What is fixed pacemaker rate?
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set at a rate no matter what
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What is demand pacemaker rate
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works when the HR drops
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What is threshold?
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lowest amount of energy needed to capture
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What is capture in pacemaker?
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depolarization of the heart by pacing stimulus
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What is inhibition in a pacemaker?
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pacing pulse withheld in response to sensed event
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What are post pacemaker insertion guidelines?
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Limit mobility for first 24 hours, observe site for hematoma, infection, monitor HR and rhythm, VS
Avoid electromagnetic fields, wear ID tag with pacemaker information, take pulse every day, keep all appts, monitor battery function |
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How long do you limit mobility after pacemaker insertion?
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24 hours
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What do you observe pacemaker insertion site for?
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hematoma, infection
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What should you avoid with pacemaker?
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electromagnetic fields
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What can you put on arm after pacemaker insertion?
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immobilizer
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What would asystole look like with a pacemaker?
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only spikes
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What do you do to patient if new pacemaker insertion has aystole
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turn on the left side to increase heart contact and if get rhythm, tell patient not to move and call the doctor
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What may cause pacemaker under sensing?
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threshold too low, wire dislodged, pt. own voltage too low
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What is treatment of under sensing for pacemaker
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increase sensitivity, chest xray to check lead placement, reposition patient to left side
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What may cause pacemaker loss of capture?
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milliamps too low, wire dislodged, loose connection
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Treatment for loss of capture for pacemaker
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increase milliamps, CXR to check position, reposition to left side, ensure connections are tight
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What do you do with pacemaker after patient dies?
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shut it off
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