Chapter 27 Med-Surg I

Front 1

waveforms of ECG

Back 1

P wave, QRS complex, T wave, and possibly a U wave

Front 2

segments and intervals of ECG

Back 2

PR interval (beg of the P wave to the beg of QRS complex), ST segment (end of the QRS complex to beg of T wave), QT interval (beg of the QRS complex to the end of the T wave), TP interval (end of the T wave to beg of the next P wave), PP interval (beg of one P wave to beg of next)

Front 3

sinus bradychardia

Back 3

when the sinus nodes creates an impulse at a slower than normal rate
caused by lower metabolic needs, vagal stimulation, meds, idiopathic sinus node dysfunction, increased intracranial pressure, MI.
also the H's and T's
atropine drug of choice IV bolus q 3-5 min
ECG:
all is normal except the rate is less than 60.

Front 4

sinus tachycardia

Back 4

when the sinus node creates an impulse at a faster than normal rate
caused by physiologic or psychological stress, meds that increase sympathetic response, stimulants, illicit drugs, enhanced automaticity of the SA node, inappropriate sinus tachycardia, autonomic dysfunction (POTS)
ECG:
all is normal except for rate is greater than 100 but usually
less than 120
always a P wave but could possibly be buried in preceding T wave
QRS is usually normal but may be regularly abnormal

Front 5

atrial flutter

Back 5

conduction defect in the atrium and causes a rapid, regular atrial rate
ECG:
atrial rate: bw 250 and 400
ventricular rate: bw 75 and 150
P wave is saw toothed shape
P:QRS ratio: 2:1, 3:1, 4:1

Front 6

atrial fibrillation

Back 6

uncoordinated atrial electrical activation that causes a rapid, disorganized and uncoordinated twitching of atrial musculature
66% increase in hospital admissions for atrial fibrillation over the past 20 years
usually found in elderly with heart disease, inflammatory disease, CAD, HTN, congenital disorder, HF, diabetes, obesity, hyperthyroidism, pheochromocytoma, pulmonary htn and embolism, sleep apnea, moderate to heavy ingestion of alcohol (holiday heart)
ECG:
atrial rate: 300-600
ventricular rate: 120-200
QRS: usually normal but may be abnormal
No discernible P waves, irregular and vary in amplitude and shape
PR interval cannot be measured
P:QRS ratio: many:1

Front 7

ventricular tachycardia

Back 7

three or more PVC's in a row,exceeding 100 bpm. seen in patients with larger MIs and lower ejection fractions - it is an emergency, the patient is usually unresponsive and pulseless
ECG:
ventricular rate: 100-200 bpm
atrial rate: depend on underlying rhythm
rhythm: usually regular
QRS: bizarre and 0.12 sec or more
PR interval: very irregular, if P waves are seen
P:QRS ratio: difficult to determine but usually more QRS if P waves are seen.

Front 8

ventricular fibrillation

Back 8

most common dysrhythmia in patients with cardiac arrest - rapid, disorganized ventricular rhythm that causes ineffective quivering of the ventricles. No atrial activity seen. most common cause is CAD and acute MI
ECG:
ventricular rate: >300
rhythm: extremely irregular
QRS: irregular waves without recognizavble QRS complexes

Front 9

treatment of ventricular fibrillation

Back 9

early defib is critical to survival with admin of CPR until defib is available - 5 cycles may be given prior to defib and after first defib
chance of survival decreases by 7-10% every minute in delay of defib
epinephrine shoudl be administered asap after 2nd rhythm check and again every 3-5 minutes (one dose of vasopressin (Pitressin) may be administered if cardiac arrest persists
after the 3rd rhythm check, other antiarrythmic meds (amiodarone, lidocaine, magnesium) should be adminstered
for refactory v fib, amiodarone may be med of choice, once pt is intubated, CPR sould be given continuously, not in cycle with rythym check and medicine administration done every 2 minutes
hypothermia may also be induced - nurse must monitor for complications of hypothermia such as electrolyte imbalance, hypotension, pneumonia, sepsis, hyperglycemia, dysrhythmias, and coagulopathy - this care is provided in ICU - 3 nurses per pt during induction process and 2 during hypothermia state

Front 10

supraventricular tachycardia

Back 10

If P waves cannot be identified - it could be SVT or PSVT (paroxysmal supraventricular tachycardia)
this indicates that the rhythm is not VT
it could be atrial fib, atrial flutter, or AVNRT (atrioventricular nodal reentry tachycardia)